Cytoreductive nephrectomy in the current treatment algorithm.

Published on Sep 27, 2019in Therapeutic Advances in Medical Oncology6.852
· DOI :10.1177/1758835919879026
Teele Kuusk10
Estimated H-index: 10
(Royal Free Hospital),
Bernadett Szabados7
Estimated H-index: 7
(QMUL: Queen Mary University of London)
+ 2 AuthorsAxel Bex8
Estimated H-index: 8
(UCL: University College London)
Sources
Abstract
The two recent prospective randomized trials CARMENA and SURTIME have changed the therapy paradigm of metastatic renal cell carcinoma. The CARMENA trial was conducted to investigate whether cytored...
References28
Newest
#1Brian I. Rini (Cleveland Clinic)H-Index: 96
#2Thomas Powles (QMUL: Queen Mary University of London)H-Index: 84
Last. Robert J. Motzer (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 140
view all 32 authors...
Summary Background A phase 2 trial showed improved progression-free survival for atezolizumab plus bevacizumab versus sunitinib in patients with metastatic renal cell carcinoma who express programmed death-ligand 1 (PD-L1). Here, we report results of IMmotion151, a phase 3 trial comparing atezolizumab plus bevacizumab versus sunitinib in first-line metastatic renal cell carcinoma. Methods In this multicentre, open-label, phase 3, randomised controlled trial, patients with a component of clear ce...
352 CitationsSource
#1Han Jie Lee (SGH: Singapore General Hospital)H-Index: 4
#2Alvin Lee (SGH: Singapore General Hospital)H-Index: 4
Last. Weber Kam On Lau (SGH: Singapore General Hospital)H-Index: 18
view all 4 authors...
Abstract Purpose The Leibovich model was updated to prognosticate oncological outcomes in postnephrectomy nonmetastatic renal cell carcinoma (RCC) for each major histological subtype including clear cell (ccRCC), papillary (papRCC), and chromophobe RCC. We evaluated its performance in an independent population of predominantly Asian patients from Singapore. Materials and Methods Nine hundred and forty two binephric patients with nonmetastatic unilateral RCC treated with radical/partial nephrecto...
4 CitationsSource
#1Arnaud Mejean (Paris V: Paris Descartes University)H-Index: 61
#2Simon Thezenas (ICM Partners)H-Index: 24
Last. Alain RavaudH-Index: 77
view all 20 authors...
4508Background: Carmena was a randomized phase III trial, testing the benefit of CN followed by sunitinib (arm A) vs sunitinib alone (arm B), with stratification by MSKCC risk groups in 450 mRCC pa...
26 CitationsSource
#1Robert J. Motzer (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 140
#2Konstantin PenkovH-Index: 4
Last. Toni K. Choueiri (Harvard University)H-Index: 116
view all 28 authors...
Abstract Background In a single-group, phase 1b trial, avelumab plus axitinib resulted in objective responses in patients with advanced renal-cell carcinoma. This phase 3 trial involving previously...
790 CitationsSource
#1Brian I. RiniH-Index: 96
#2Elizabeth R. Plimack (Fox Chase Cancer Center)H-Index: 61
Last. Thomas PowlesH-Index: 84
view all 27 authors...
Abstract Background The combination of pembrolizumab and axitinib showed antitumor activity in a phase 1b trial involving patients with previously untreated advanced renal-cell carcinoma. Whether p...
969 CitationsSource
#1Axel Bex (NKI-AVL: Netherlands Cancer Institute)H-Index: 54
#2Peter F.A. Mulders (Radboud University Nijmegen)H-Index: 79
Last. John B. A. G. Haanen (NKI-AVL: Netherlands Cancer Institute)H-Index: 77
view all 20 authors...
Importance In clinical practice, patients with primary metastatic renal cell carcinoma (mRCC) have been offered cytoreductive nephrectomy (CN) followed by targeted therapy, but the optimal sequence of surgery and systemic therapy is unknown. Objective To examine whether a period of sunitinib therapy before CN improves outcome compared with immediate CN followed by sunitinib. Design, Setting, and Participants This randomized clinical trial began as a phase 3 trial on July 14, 2010, and continued ...
140 CitationsSource
#1Bimal Bhindi (Mayo Clinic)H-Index: 20
#2E. Jason Abel (UW: University of Wisconsin-Madison)H-Index: 18
Last. Axel Bex (NKI-AVL: Netherlands Cancer Institute)H-Index: 54
view all 10 authors...
Abstract Context The role of cytoreductive nephrectomy (CN) in the management of metastatic renal cell carcinoma (mRCC) in the targeted therapy (TT) era is controversial. Objective To assess if CN versus no CN is associated with improved overall survival (OS) in patients with mRCC treated in the TT era and beyond, characterize the morbidity of CN, identify prognostic and predictive factors, and evaluate outcomes following treatment sequencing. Evidence acquisition Medline, EMBASE, and Cochrane d...
69 CitationsSource
#1Axel Bex (NKI-AVL: Netherlands Cancer Institute)H-Index: 54
#2Laurence Albiges (Université Paris-Saclay)H-Index: 58
Last. Thomas Powles (QMUL: Queen Mary University of London)H-Index: 84
view all 18 authors...
Cytoreductive nephrectomy (CN) has been the standard of care in patients with metastatic clear-cell renal cancer who present with the tumour in place. The CARMENA trial compared systemic therapy al ...
51 CitationsSource
#1Arnaud Mejean (Paris V: Paris Descartes University)H-Index: 61
#2Alain Ravaud (Paris V: Paris Descartes University)H-Index: 77
Last. B. J. Escudier (Paris V: Paris Descartes University)H-Index: 23
view all 29 authors...
Abstract Background Cytoreductive nephrectomy has been the standard of care in metastatic renal-cell carcinoma for 20 years, supported by randomized trials and large, retrospective studies. However, the efficacy of targeted therapies has challenged this standard. We assessed the role of nephrectomy in patients with metastatic renal-cell carcinoma who were receiving targeted therapies. Methods In this phase 3 trial, we randomly assigned, in a 1:1 ratio, patients with confirmed metastatic clear-ce...
329 CitationsSource
#1Hans J. Hammers (Johns Hopkins University)H-Index: 53
#2Elizabeth R. Plimack (Fox Chase Cancer Center)H-Index: 61
Last. Asim Amin (Carolinas Healthcare System)H-Index: 27
view all 15 authors...
PurposeCombination treatment with immune checkpoint inhibitors has shown enhanced antitumor activity compared with monotherapy in tumor types such as melanoma. The open-label, parallel-cohort, dose-escalation, phase I CheckMate 016 study evaluated the efficacy and safety of nivolumab plus ipilimumab in combination, and nivolumab plus a tyrosine kinase inhibitor in metastatic renal cell carcinoma (mRCC). Safety and efficacy results from the nivolumab plus ipilimumab arms of the study are presente...
242 CitationsSource
Cited By7
Newest
#1Ami Rambhia (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 2
#2Rutul D Patel (ISMMS: Icahn School of Medicine at Mount Sinai)
Last. Ketan K. Badani (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 25
view all 5 authors...
Abstract null null Recent innovations in systemic therapy for metastatic renal cell carcinoma (mRCC) have occurred at a break-neck pace. In the 1980s, nontargeted cytokine-mediated immunotherapy was the systemic therapy of choice. Based on improvements in tolerability and patient outcomes, targeted antiangiogenic agents supplanted cytokines in the early 2000s. During the last decade, the most recent innovation has come in the form of immune-checkpoint inhibitors (ICIs), a form of immunotherapy t...
Source
#1Arnaud MejeanH-Index: 61
#2Alain Ravaud (University of Bordeaux)H-Index: 77
Last. Laurent GuyH-Index: 26
view all 24 authors...
Abstract null null Background null The CARMENA trial in patients with metastatic renal cell carcinoma (mRCC) demonstrated that treatment with sunitinib alone was noninferior to cytoreductive nephrectomy (CN) followed by sunitinib (nephrectomy–sunitinib). null null null Objective null The objective of this study was to provide updated overall survival (OS) outcomes of CARMENA and assess whether some subgroups may still benefit from upfront CN. null null null Design, setting, and participants null...
1 CitationsSource
#1Eduard Roussel (Katholieke Universiteit Leuven)H-Index: 3
#2Annelies Verbiest (Katholieke Universiteit Leuven)H-Index: 7
Last. Maarten Albersen (Katholieke Universiteit Leuven)H-Index: 26
view all 8 authors...
The prospective CARMENA trial surprisingly suggested that patients with upfront metastatic clear-cell renal cell carcinoma (m-ccRCC) would not benefit from cytoreductive nephrectomy (CN). We aimed ...
2 CitationsSource
#1Julien Sarkis (St. Joseph Hospital)H-Index: 2
#2Pierre Sarkis (St. Joseph Hospital)H-Index: 2
Dear Editor, The author [1] exposed an overlooked issue that every urologist is facing during this critical period. Patient’s fear of contracting severe acute respiratory syndrome coronavirus 2 (SA...
1 CitationsSource
#1Eduard Roussel (Katholieke Universiteit Leuven)H-Index: 3
#2Riccardo Campi (UniFI: University of Florence)H-Index: 13
Last. Maarten Albersen (Katholieke Universiteit Leuven)H-Index: 26
view all 33 authors...
Abstract Background Cytoreductive nephrectomy (CN) plays an important role in the treatment of a subgroup of metastatic renal cell carcinoma (mRCC) patients. Objective We aimed to evaluate morbidity associated with this procedure and identify potential predictors thereof to aid patient selection for this procedure and potentially improve patient outcomes. Design, setting, and participants Data from 736 mRCC patients undergoing CN at 14 institutions were retrospectively recorded in the Registry f...
4 CitationsSource
#1Amanda Nizam (Cleveland Clinic)H-Index: 1
#2Jonah A. Schindelheim (Touro College of Osteopathic Medicine)H-Index: 1
Last. Moshe Chaim Ornstein (Cleveland Clinic)H-Index: 15
view all 3 authors...
ABSTRACT Treatment of metastatic renal cell carcinoma (mRCC) has been revolutionized by an expanding armamentarium of systemic therapies, which have resulted in improved patient outcomes. Multimodal approaches that include cytoreductive nephrectomy (CN), immunotherapy, and targeted therapy are necessary to optimize clinical care. Active surveillance (AS) and CN are two cornerstones of treatment in mRCC which require reexamination in the context of new systemic therapies. Herein, we review the da...
4 CitationsSource
#1Igal Kushnir (TAU: Tel Aviv University)H-Index: 4
#1Igal Kushnir (Ottawa Hospital)H-Index: 1
Last. Neil Reaume (U of O: University of Ottawa)H-Index: 3
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4516Background: Active surveillance (AS) is a commonly used strategy in patients (pts) with low tumor burden or slow growing disease. However, few studies have assessed AS for mRCC compared to imme...
4 CitationsSource